Two cases of a very rare complication in patients with acute post-transplant kidney insufficiency

Abstract

Background. Renal transplantation is performed in thousands of patients with end-stage renal disease. The most common complications are ureteral or ureterovesical junction pathologies. We describe two very rare cases of a complication of unknown mechanism following renal transplant. Case report 1: A 57-year-old woman was evaluated after renal transplantation. The graft did not regain its function postoperatively because of acute posttransplant renal insufficiency. Redon tube drainage rose to 575 ml on day 11 and to 1360 ml on day 12. Fluid analysis and cystography led to the conclusion that no ureteroneocystostomy existed. Reoperation followed. The kidney was rescued and the patient discharged in good condition. Case report 2: A 30-year-old woman with acute posttransplant renal insufficiency after renal transplantation was evaluated. Drain tubes were removed on day 8. Graft biopsy was performed on day 16 because of suspected acute graft rejection. No aberrancies on histology were seen. The patient’s general condition worsened and ascites developed. During cystoscopy, no distal end of the JJ-cathether was seen, which led to the conclusion that no ureteroneocystostomy existed. She was reoperated on day 23 posttransplant. The kidney was rescued and the patient was discharged in good condition. Conclusions. The most common cause of urine leakage in kidney transplant recipients is ureteroneocystostomy leak. The possibility of a lack of any junction between the ureter and bladder should be taken into account. Cystoscopy and cystography, which are fast to perform and not cumbersome to the patient, should be performed early as they allow for fast and reliable diagnosis before reoperation.